ANNEX C
STANDARD SUBMISSION FORM
Provision of office supplies and stationery
F-SU-16-T01	
SUBMITTED BY:
Name: 	……………………………………………
Contact person:  ………………………………………
Address:	……………………………………………
Phone:		……………………………………………
Fax:		……………………………………………
Email: 		……………………………………………
1. PREAMBLE
Tenderers are requested to include in their tenders all the information and documents requested in the forms attached, in accordance with Annex A – Tender Specifications and the instructions below:
All forms must be dated, signed and stamped by a person authorised to sign on behalf of the tenderer. 
In case of a consortium or group of companies, the tender must be signed by the person appointed in the power of attorney (Form A.4) as authorised to sign the tender on behalf of the consortium or group of companies. 
Each consortium partner must sign a Declaration of Honour with respect to the Exclusion Criteria and Absence of Conflict of Interest (Form B.1). For each identified subcontractor whose intended share of the contract is above 10% of the total contract amount, a signed Declaration of Honour must also be provided.
Each identified subcontractor must complete and sign the Letter of Intent included in Form A.6. 
If the tenderer relies on the economic, financial, technical and professional capacity of the proposed subcontractor(s) to meet the selection criteria, then the subcontractors shall also complete the forms included under Parts C and D. In any other case, the forms included under Parts C and D shall only be completed by the tenderer or by the partners in case of consortium or group of companies. 
In addition to the forms requested in this Annex C, tenderers must submit their technical proposal in a separate envelope clearly marked as “Technical Offer”. Please note that there is no specific template to submit the technical proposal. However, it should be drawn up following the instructions given in Annex A –Tender Specifications and covering all requirements of Annex A.1 Technical Specifications. 
Tenderers’ financial offer shall be prepared in accordance with Form F.1 and shall be submitted in a separate sealed envelope clearly stating “Financial Offer”.
2. CHOICE OF LOT(S) 
Not applicable.
PART A – TENDERERS IDENTIFICATION

FORM A.1 – ADMINISTRATIVE DETAILS	
1. TENDERER’S DETAILS	
Company or organisations’ name		
Legal form		
Date of registration		
Country of registration		
Registration number		
VAT number		
Address of registered office		
Contact address (if different)		
URL		
			
2. TENDERERS’ LEGAL REPRESENTATIVE(S)	
Person authorised to sign the contract on behalf of the tenderer:	
Surname		
Forename		
Function		
Telephone		
Fax		
Email		
Contact person regarding this tender:	
Surname		
Forename		
Function		
Telephone		
Fax		
Email		
Signed (authorised signature) on behalf of the Tenderer
Full name:	……………………………………………
Date:		……………………………………………
Signature:	……………………………………………		Stamp:	……………………………
FORM A.2 – LEGAL ENTITIES FORM
A standard template in each EU language is available at:
http://ec.europa.eu/budget/contracts_grants/info_contracts/legal_entities/legal_entities_en.cfm
Please choose the appropriate form (legal entity form for either individuals, private companies or public entities) and attach the necessary supporting documents as required (see instructions in the file).

FORM A.3 – BANK IDENTIFICATION FORM
A standard template in each EU language is available at:
http://ec.europa.eu/budget/contracts_grants/info_contracts/financial_id/financial_id_en.cfm

FORM A.4 – POWER OF ATTORNEY
(DESIGNATING ONE OF THE COMPANIES OF THE GROUP AS LEADER AND GIVING A MANDATE TO IT)
We, the undersigned:
– Signatory 1 (Name, Function, Company, Registered address, VAT Number)
– Signatory 2 (Name, Function, Company, Registered address, VAT Number)
– …..
– Signatory N (Name, Function, Company, Registered address, VAT Number),
Each of them having the legal capacity required to act on behalf of his/her company,
HEREBY AGREE AS FOLLOWS:
1.	In case the European Union Agency for Fundamental Rights awards the Contract F-SU-16-T01 (the Contract) to Company 1, Company 2, …, Company N (the Group Members), based on the joint offer submitted by them on [to be completed] for the provision of Supplies the Supplies, all the partners, as co-signatories of the Contract:
a.	Shall be jointly and severally liable towards the European Union Agency for Fundamental Rights for the performance of the Contract.
b.	Shall comply with the terms and conditions of the Contract and ensure the proper execution of their respective share of the supplies.
2.	To this effect, the Group Members designate Company [to be completed] as Group Leader.
3.	Payments by the European Union Agency for Fundamental Rights related to the Supplies or the Services shall be made through the Group Leader’s bank account.
4.	The Group Members grant to the Group Leader all the necessary powers to act on their behalf in connection with the supplies. This mandate involves in particular the following tasks:
a.	The Group Leader shall sign any contractual documents — including the Contract — and issue any invoices related to the supplies on behalf of the Group Members.
b.	The Group Leader shall act as single point of contact for the European Union Agency for Fundamental Rights in connection with the supplies to be provided under the Contract. It shall co-ordinate the provision of the supplies by the Group Members to the European Union Agency for Fundamental Rights, and shall see to a proper administration of the Contract.
Any modification to the present agreement / power of attorney shall be subject to approval from the European Union Agency for Fundamental Rights.
This agreement / power of attorney shall expire when all the contractual obligations of the Group Members towards the European Union Agency for Fundamental Rights in connection with the supplies to be provided under the Contract have ceased to exist. The parties cannot terminate it before that date without the consent of the European Union Agency for Fundamental Rights.

Signed in	…………………… on  ………………………
Name		……………………………………………………
Function	……………………………………………………
Company	……………………………………………………

FORM A.5 – STATEMENT ON SUBCONTRACTING
Please indicate (by ticking the appropriate box) whether the tenderer intends to subcontract all or part of the performance of the Contract, if awarded.
□	YES, the tenderer intends to subcontract all or part of the performance of the Contract, if awarded.
□	NO, the tenderer does not intend to subcontract all or part of the performance of the Contract, if awarded.
If YES, please specify which parts of the Contract, and the name and address of any subcontractor(s).
Description	Percentage of the contract	Subcontractor	
	%	Name:
Address:	
	%	Name:
Address:	
	%	Name:
Address:	
	%	Name:
Address:	
Signed (authorised signature) on behalf of the Tenderer
Full name:	………………………………………
Date:		………………………………………
Signature:	………………………………………	Stamp:	………………………………………

FORM A.6 – LETTER OF INTENT FOR SUBCONTRACTORS
The undersigned: 
[complete]
Name of the company/organisation: 
[complete]
Address: 
[complete]
Tender reference:
F-SU-16-T01
Declares hereby that, in case the contract is awarded to [name of the tenderer], the company/organisation that he/she represents, intends to collaborate in the execution of the tasks subject to this call for tender, in accordance with the technical specifications and the tender to which the present form is annexed, and is available to carry out its part of the tasks during the period foreseen for the execution of the contract.  
Declares hereby accepting the General Conditions of the Draft Contract attached to the invitation to tender for the above call for tenders, and in particular, those provisions referring to subcontracting and check and audits.

Place and date:	……………………………………………

Name and signature:	……………………………………………
PART B & C – EXCLUSION CRITERIA AND SELECTION CRITERIA

FORM B.1 - DECLARATION ON HONOUR ON EXCLUSION CRITERIA AND SELECTION CRITERIA
The undersigned [insert name of the signatory of this form], representing:
(only for natural persons) himself or herself	(only for legal persons) the following legal person:	
ID or passport number: 

(‘the person’)	Full official name:
Official legal form: 
Statutory registration number: 
Full official address: 
VAT registration number: 

(‘the person’)	

1.	declares whether the above-mentioned person is in one of the following situations or not:	
Situation of exclusion concerning the person	YES	NO	
a)	it is bankrupt, subject to insolvency or winding up procedures, its assets are being administered by a liquidator or by a court, it is in an arrangement with creditors, its business activities are suspended or it is in any analogous situation arising from a similar procedure provided for under national legislation or regulations;			
b)	it has been established by a final judgement or a final administrative decision that the person is in breach of its obligations relating to the payment of taxes or social security contributions in accordance with the law of the country in which it is established, with those of the country in which the contracting authority is located or those of the country of the performance of the contract;			
c)	it has been established by a final judgement or a final administrative decision that the person is guilty of grave professional misconduct by having violated applicable laws or regulations or ethical standards of the profession to which the person belongs, or by having engaged in any wrongful conduct which has an impact on its professional credibity where such conduct denotes wrongful intent or gross negligence, including, in particular, any of the following:		
i)	fraudulently or negligently misrepresenting information required for the verification of the absence of grounds for exclusion or the fulfilment of selection criteria or in the performance of a contract;			
ii)	entering into agreement with other persons with the aim of distorting competition;			
iii)	violating intellectual property rights;			
iv)	attempting to influence the decision-making process of the contracting authority during the award procedure;			
v)	attempting to obtain confidential information that may confer upon it undue advantages in the award procedure;			
d)	it has been established by a final judgement that the person is guilty of the following:		
i)	fraud, within the meaning of Article 1 of the Convention on the protection of the European Communities' financial interests, drawn up by the Council Act of 26 July 1995;			
ii)	corruption, as defined in Article 3 of the Convention on the fight against corruption involving officials of the European Communities or officials of EU Member States, drawn up by the Council Act of 26 May 1997, and in Article 2(1) of Council Framework Decision 2003/568/JHA, as well as corruption as defined in the legal provisions of the country where the contracting authority is located, the country in which the person is established or the country of the performance of the contract;			
iii)	participation in a criminal organisation, as defined in Article 2 of Council Framework Decision 2008/841/JHA;			
iv)	money laundering or terrorist financing, as defined in Article 1 of Directive 2005/60/EC of the European Parliament and of the Council;			
v)	terrorist-related offences or offences linked to terrorist activities, as defined in Articles 1 and 3 of Council Framework Decision 2002/475/JHA, respectively, or inciting, aiding, abetting or attempting to commit such offences, as referred to in Article 4 of that Decision;			
vi)	child labour or other forms of trafficking in human beings as defined in Article 2 of Directive 2011/36/EU of the European Parliament and of the Council;			
e)	the person has shown significant deficiencies in complying with the main obligations in the performance of a contract financed by the Union’s budget, which has led to its early termination or to the application of liquidated damages or other contractual penalties, or which has been discovered following checks, audits or investigations by an Authorising Officer, OLAF or the Court of Auditors;			
f)	it has been established by a final judgment or final administrative decision that the person has committed an irregularity within the meaning of Article 1(2) of Council Regulation (EC, Euratom) No 2988/95;			
g)	for the situations of grave professional misconduct, fraud, corruption, other criminal offences, significant deficiencies in the performance of the contract or irregularity, the applicant is subject to:
i)	facts established in the context of audits or investigations carried out by the Court of Auditors, OLAF or internal audit, or any other check, audit or control performed under the responsibility of an authorising officer of an EU institution, of a European office or of an EU agency or body;
ii)	non-final administrative decisions which may include disciplinary measures taken by the competent supervisory body responsible for the verification of the application of standards of professional ethics;
iii)	decisions of the ECB, the EIB, the European Investment Fund or international organisations;
iv)	decisions of the Commission relating to the infringement of the Union's competition rules or of a national competent authority relating to the infringement of Union or national competition law; or
v)	decisions of exclusion by an authorising officer of an EU institution, of a European office or of an EU agency or body.			

II – Situations of exclusion concerning natural persons with power of representation, decision-making or control over the legal person
Not applicable to natural persons, Member States and local authorities
2.	declares that a natural person who is a member of the administrative, management or supervisory body of the above-mentioned legal person, or who has powers of representation, decision or control with regard to the above-mentioned legal person (this covers company directors, members of management or supervisory bodies, and cases where one natural person holds a majority of shares) is in one of the following situations:	YES	NO	N/A	
Situation (c) above (grave professional misconduct)				
Situation (d) above (fraud, corruption or other criminal offence)				
Situation (e) above (significant deficiencies in performance of a contract )				
Situation (f) above (irregularity)				
III – Situations of exclusion concerning natural or legal persons assuming unlimited liability for the debts of the legal person
3.	declares that a natural or legal person that assumes unlimited liability for the debts of the above-mentioned legal person is in one of the following situations:	YES	NO	N/A	
Situation (a) above (bankruptcy)				
Situation (b) above (breach in payment of taxes or social security contributions)				
IV – Grounds for rejection from this procedure
4.	declares that the above-mentioned person:	YES	NO	
h)	has distorted competition by being previously involved in the preparation of procurement documents for this procurement procedure. 			
V – Remedial measures
If the person declares one of the situations of exclusion listed above, it must indicate measures it has taken to remedy the exclusion situation, thus demonstrating its reliability. This may include e.g. technical, organisational and personnel measures to prevent further occurrence, compensation of damage or payment of fines. The relevant documentary evidence which illustrates the remedial measures taken must be provided in annex to this declaration. This does not apply for situations referred in point (d) of this declaration.
VI – Evidence upon request
Upon request and within the time limit set by the contracting authority the person must provide information on the persons that are members of the administrative, management or supervisory body. It must also provide the following evidence concerning the person itself and concerning the natural or legal persons which assume unlimited liability for the debt of the person:
For situations described in (a), (c), (d) or (f), production of a recent extract from the judicial record is required or, failing that, an equivalent document recently issued by a judicial or administrative authority in the country of establishment of the person showing that those requirements are satisfied. 
For the situation described in point (a) or (b), production of recent certificates issued by the competent authorities of the State concerned are required. These documents must provide evidence covering all taxes and social security contributions for which the person is liable, including for example, VAT, income tax (natural persons only), company tax (legal persons only) and social security contributions. Where any document described above is not issued in the country concerned, it may be replaced by a sworn statement made before a judicial authority or notary or, failing that, a solemn statement made before an administrative authority or a qualified professional body in its country of establishment.
The person is not required to submit the evidence if it has already been submitted for another procurement procedure. The documents must have been issued no more than one year before the date of their request by the contracting authority and must still be valid at that date. 
The signatory declares that the person has already provided the documentary evidence for a previous procedure and confirms that there has been no change in its situation:
Document	Full reference to previous procedure	
Insert as many lines as necessary.		
VII – Selection criteria 
5.	declares that the above-mentioned person complies with the selection criteria applicable to it individually as provided in the tender specifications:	YES	NO	N/A	
(a)	It has the legal and regulatory capacity to pursue the professional activity needed for performing the contract as required in section 19.2.2 of the tender specifications;				
(b)	It fulfills the applicable economic and financial criteria indicated in section 19.2.1 of the tender specifications;				
(c)	It fulfills the applicable technical and professional criteria indicated in section 19.2.2 of the tender specifications.				
6.	if the above-mentioned person is the sole tenderer or the leader in case of joint tender, declares that: 	YES	NO	N/A	
(d)	the tenderer, including all members of the group in case of joint tender and including subcontractors if applicable, complies with all the selection criteria for which a consolidated asseessment will be made as provided in the tender specifications.				
VII – Evidence for selection
The signatory declares that the above-mentioned person is able to provide the necessary supporting documents listed in the relevant sections of the tender specifications and which are not available electronically upon request and without delay.
The person is not required to submit the evidence if it has already been submitted for another procurement procedure. The documents must have been issued no more than one year before the date of their request by the contracting authority and must still be valid at that date. 
The signatory declares that the person has already provided the documentary evidence for a previous procedure and confirms that there has been no change in its situation: 
Document	Full reference to previous procedure	
Insert as many lines as necessary.		

The above-mentioned person may be subject to rejection from this procedure and to administrative sanctions (exclusion or financial penalty) if any of the declarations or information provided as a condition for participating in this procedure prove to be false.

Full name:………………………………  Date:……………………………

Signature:………………………………  Stamp:…………………………
EVIDENCE FOR SELECTION CRITERIA (ECONOMIC AND FINANCIAL CAPACITY)

FORM C.1 – COPY OF THE PROFIT AND LOSS ACCOUNTS AND BALANCE SHEET
Please attach copy of the profit and loss accounts and balance sheet in accordance with the instructions provided in Annex A – Tender Specifications.

FORM C.2 – STATEMENT OF ANNUAL TURNOVER
Please fill in the table below in accordance with the instructions provided in Annex A – Tender Specifications: 
Statement on annual overall turnover (in EURO)	
Tenderer’s name	Current year -2	Current year -1	
Partner 1			
Partner 2			
Etc…			
Total			
(please add rows and columns if needed).] 

Signed (authorised signature) on behalf of the Tenderer
Full name:	……………………………………………
Date:		……………………………………………
Signature:	……………………………………………		Stamp:………………………………………

SECTION D – SELECTION CRITERIA (TECHNICAL AND PROFESSIONAL CAPACITY)

FORM D. 1 - (A) 	A LIST OF THE PRINCIPAL SERVICES PROVIDED IN THE PAST THREE (3) YEARS. 
TENDERERS ARE REQUIRED TO PROVE THAT THEY HAVE PROVIDED SIMILAR SERVICES TO AT LEAST TWO CLIENTS OF AN AMOUNT/NATURE OR SCOPE SIMILAR TO THE SERVICES TO BE CARRIED OUT UNDER THIS CONTRACT. 

	
FORM D. 2 - FOR THESE TWO CLIENTS, THE LIST OF THE PRINCIPAL SERVICES PROVIDED SHALL BE ACCOMPANIED BY CERTIFICATES OF SATISFACTORY PERFORMANCE AND COMPLETION OF THE SERVICES  

	
PART E – FINANCIAL GUARANTEES
This part is not applicable to this tender.
PART F – FINANCIAL OFFER

FORM F.1 – FINANCIAL OFFER TEMPLATE
[To be submitted in a separate sealed envelope clearly stating "Financial Offer" following the instructions laid down in Annex A – Tender Specifications]
F-SU-16-T01
Provision of office supplies and stationery
IDENTIFICATION OF THE TENDERER:
Name: 		……………………………………………
Contact person: 	……………………………………………
Address: 		……………………………………………
Phone: 		……………………………………………
Fax: 			……………………………………………
Email: 			……………………………………………
Financial proposal in Euro 
(based on the information given in Annexes A and A.1 covering financial award criteria)	
Item	Price 	Weighting in %	
High quality A4 white recycling copy paper/80 gr for S/W print/copy machines/fax/laser/inkjet printe - pckg 500 sheets		28	
High quality A4 white copy paper/ 80 gr for S/W print/copy machines/fax/laser/inkjet printer - pckg 500 sheets		9	
Whiteboard marker x 1 (all colours), round-end, size 2,0 mm		3	
Stapler/staples 24/6 - single		2	
Puncher/two holes - capacity 10 pages		2	
Pen width 0,4 mm - single		5	
Highlighter/yellow/blue/pink/width 5 mm - single		3	
Notepad/A5/with lines - single		5	
Notepad/A4/with lines - single		2	
Paper clip/50 mm - pckg 100 pieces		3	
Punch/up to 30 pages - single		2	
Folder/A4/with 9 separations/hard cardboard cover - single		3	
Desk annual calendar/A4 - single		2	
Name pads with clip/60*90 mm -single		3	
Sheet protector/A4 with holes - pckg 100 pieces		7	
Folder A4/conv. nameplate/front size 75 mm/black - pckg 10 pieces		7	
Folder A4/conv. nameplate/front size 50 mm/black - pckg 10		6	
Post-it sticky notes 7,6x7,6, 100 sheets, pack of 6		3	
Batterries size AA, pack of 10		5	
TOTAL		100	
Percentage reduction of the official price list prices (if applicable): 		
Link to the official price list:……………………………………………………………………  

Signed (authorised signature) on behalf of the Tenderer
Full name:	……………………………………………
Date:		……………………………………………
Signature:	……………………………………………		Stamp:………………………………………